Calcium, vitamin D, exercise and bone health

February 4, 2013

New guidelines published in the Medical Journal of Australia's open access journal (MJA OPEN) reveal calcium, vitamin D and exercise are the key to Australia's bone health.

'Building Healthy Bones Throughout Life: an evidence informed strategy to prevent osteoporosis in Australia' presents key recommendations for different stages of life.

This 18 month body of work has culminated in today's publication of key guidelines that are essential to the bone health of all Australians. Instigated by Osteoporosis Australia, and commenced with a national summit, over 100 leading experts, from a range of disciplines, had the opportunity to analyse and critique evidence specific to bone health and prevention strategies.

The nation's bone health needs addressing as 1.2 million Australians have osteoporosis and 6.3 million have osteopenia (low bone density)*. Over 80,000 Australians suffer minimal trauma fractures each year.**

Professor Peter Ebeling, Medical Director of Osteoporosis Australia and lead author on the paper said "When we look at optimising bone health, we must look at the whole life cycle and extensive research gives us clear directions on what is required at different ages."

"This paper clearly identifies the central role a combination of adequate calcium, vitamin D and exercise provides at all life stages, to improve our nation's bone health," said Prof Ebeling.

"The clear message today is we have an opportunity to make a difference to bone health for all Australians. We have the tools, but we now have to use them all. Our call is to both the public and general practitioners to focus more attention on bone health."

Ovarian Conservation Versus Bilateral Oophorectomy at the Time of Hysterectomy for Benign Disease

Observational studies suggest that elective bilateral oophorectomy may do more harm than good. Removing the ovaries at the time of hysterectomy for benign disease should be approached with caution, especially for women younger than age 50. For women who choose oophorectomy, some evidence suggests that menopausal estrogen therapy may ameliorate some of the increased risk. An informed consent process covering the risks and benefits of both oophorectomy and ovarian conservation is important.

Exercise boosts diet benefits

Obese older adults can reduce their chances of developing the metabolic syndrome which raises the risk of diabetes and heart disease by adding exercise to a diet regime, research shows.

The study followed 107 obese adults aged 65 and older for one year and randomised them to four groups – weight management with a calorie-restricted diet, three 90-minute exercise sessions a week without dieting, combined dieting with exercise, and controls (no diet or exercise.)

The combination of diet and exercise nearly doubled the improvement in insulin sensitivity compared with dieting alone. The insulin sensitivity index did not improve in controls but improved by 40 per cent in the diet group and by 70 per cent in the combined diet-exercise group.

Weight loss lowers cancer risk

Even moderate weight loss can significantly reduce levels of circulating oestrogens which are associated with an increased risk of breast cancer, US researchers have found.

Results suggested that losing just five per cent or more of one's weight could cut by a quarter to a half the risk for the most common, oestrogen-sensitive breast cancer said researcher, director of the Prevention Centre at Fred Hutchinson Cancer Research Centre, Dr Anne McTiernan.

The study in 439 overweight to obese sedentary women aged 50 to 75 was the first to show that losing weight through a healthy diet significantly lowered blood oestrogen levels in postmenopausal women and led to average weight losses of 10 percent of their starting weight. The most striking effect was if diet was combined with exercise.

"This shows that it's never too late to make lifestyle changes to reduce your risk for breast cancer," Dr McTiernan said.

Oestrogen only HRT reduces breast cancer risk

Women who have had a hysterectomy and who use oestrogen-only hormone replacement therapy appear less likely to develop breast cancer in the long term than women who have never used HRT, new findings published by the Lancet today, Wednesday 7 March 2012, indicate.

Researchers followed postmenopausal women for nearly 12 years and found a 23% reduction in the incidence of invasive breast cancer in those who had used conjugated equine oestrogen therapy for an average 5.9 years, compared with women on placebo.

Those on oestrogen therapy who did develop breast cancer were also much less likely to die from the cancer than women who developed breast cancer in the placebo group.

Smoking lowers menopause age

Women who smoke have a higher risk of early natural menopause, a review of eleven studies involving about 50,000 women has found.

The meta-analysis, published in the February edition of Menopause journal, provides more evidence to suggest that smoking is a significant independent risk factor for early menopause.

Natural menopause usually occurs about age 50. One group of studies in the meta-analysis found smoking increased the risk of menopause occurring before this age by about 43 per cent. Another group of studies found smoking brought forward menopause by about one year.

Early natural menopause is associated with a higher risk of cardiovascular diseases, genital tract cancers and osteoporosis.